Provider Demographics
NPI:1972939536
Name:MEGARO, JESSICA (PT)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MEGARO
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:BUDD LAKE
Mailing Address - State:NJ
Mailing Address - Zip Code:07828-3009
Mailing Address - Country:US
Mailing Address - Phone:973-362-0155
Mailing Address - Fax:973-741-4200
Practice Address - Street 1:197 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:BUDD LAKE
Practice Address - State:NJ
Practice Address - Zip Code:07828
Practice Address - Country:US
Practice Address - Phone:973-362-0155
Practice Address - Fax:973-741-4200
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-16
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ40QA01505300225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist